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Incorporation of Registries in Electronic Health Records (and vice versa) ASTHO Immunization Registry Summit Wednesday, August 4, 2010 Crystal City, VA. Gus Birkhead, M.D., M.P.H. Deputy Commissioner, Office of Public Health New York State Department of Health. NYS IIS History.

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Incorporation of Registries in Electronic Health Records(and vice versa)ASTHO Immunization Registry Summit Wednesday, August 4, 2010Crystal City, VA

Gus Birkhead, M.D., M.P.H.

Deputy Commissioner, Office of Public Health

New York State Department of Health

nys iis history
NYS IIS History

New York State (outside of New York City)

Voluntary participation since 1994.

Regional registry model

Legacy system required installation of software and updates on each office computer.

Individual consent required.

New York City has mandatory registry (NYCIR) since 1997.

nys public health law 2168
NYS Public Health Law 2168

Effective January 1, 2008,

Mandatory reporting by health care providers of immunizations given to persons age <19 years.

Consent not required

Past immunization history must be reported if not previously reported.

With written consent, immunizations given to persons 19 years and older can be reported.

Vital records birth certificate information, including immunizations administered at birth, “seed” the NYSIIS.

Allows NYSIIS – NYCIR data exchange

nyiis implementation
NYIIS Implementation

As of May 1, 2010:

3.1 million patients

36.4 million immunizations

9,200+ individual users

3,100+ health care provider practices

1,500+ schools

Coverage: 78.7% of NYS children (outside of NYC) age <6 years have >2 shots in NYSIIS

nysiis implementation and ehrs
NYSIIS Implementation and EHRs

NYSIIS accepts standard HL-7 messages via batch load from EHRs

Certified 56 vendors serving 664 practices, plus 141 practices using in house systems. 10 million of the 17 million annual transactions.

An additional 18 vendors are in process of certification

Exchanging with 8 managed care plans for HEDIS

Barriers:

Not bi-directional or real time.

Not automated.

Vendor by vendor/practice by practice set up.

Not all practices served by certified vendors have current EMR software or are willing to pay for NYSIIS service.

New version of HL7 2.5.1 requires upgrading NYSIIS and vendor software.

link nysiis to the new state hie infrastructure
Link NYSIIS to the New State HIE Infrastructure

$1 billion public and private investment in the Statewide Health Information Network for New York, or SHIN-NY;

Testing the Universal Public Health Node (UPHN), a system designed facilitate bi-directional data between State DOH and local health information exchanges across the state for public health functions;

Replace batch uploads to NYSIIS from EMRs.

child health information integration project chi 2
Child Health Information Integration Project – CHI2

Integrate child health data held by state health department, to benefit providers, PH programs and children.

Initially use NYSIIS as a base

Lead laboratory results

Newborn hearing screening results

Develop an integrated system built on the statewide information infrastructure:

Newborn Metabolic Screening Program

Early Intervention (0-3 yrs) – 75,000/year

WIC (pregnant women and kids age 0-5) –

SPARCS Hospital discharge incl. ED visits

eMedNY Medicaid billing system

chi 2 vision
CHI2 Vision

Physician with patient

Immunizations

Lead

Newborn screening

WIC services

Pharmacy history

Early intervention program services

Pharmacy utilization

Etc.

PH Program Manager

Follow up kids with conditions of public health interest (lead)

Quality monitoring

Monitor population health

PH Administrator

Program monitoring and administration

Reimbursement

  • PH Researcher
    • Conduct studiesto create generalizable knowledge
  • Parents/families
    • Assurance of complete medical history
    • Maximize care
    • Minimize unnecessary or dangerous care
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Child Health Information Initiative (CHI2)Overview of Integration Components

Available Data Sources

Original Source

Applications

(NYSIIS, SPDS,

etc.)

NYSDOH Systems Environment

DOH Vital

Records

(SPDS)

Other

External Partners

(OTDA, OCFS, etc.)

CHI2 Environment

(Hardware & software: TBD)

DOH

Immunization

Registry

(NYSIIS)

DOH

Researchers

Providers

Source Data Access layer

CHI2 Data Access Layer

DOH

Childhood

Lead Registry

Linkages to Map Child Source Records

CHI2-Enhanced

Source Applications

Statewide

Health

Information

Network

for

New York

(SHIN-NY)

…Other DOH Child Health

Information Systems

New

CHI2-Specific

Applications

principles for chi 2 development
Principles for CHI2 Development

Maximize the use of the existing information infrastructure

Develop a standard infrastructure that promotes everyday use, access and data sharing

Improve bidirectional communication

Employ standards to assure a seamless flow of information

approaches to support iis development and integration
Approaches to Support IIS Development and Integration

ARRA: Funds used to accelerate work on a universal public health node to connect internal and external systems together

Health Care Reform - Meaningful use criteria, guidance and funding to support enhanced ability for clinical data to be reported, aggregated and analyzed for public health purposes.

Statewide IT policy planning

public health hie and ehrs factors to consider
Public Health, HIE and EHRs – Factors to Consider

Broader thinking by Public Health about the potential for new uses of data;

Overcome barriers of silo funding/thinking;

Funding to support system upgrades is critical; for example funding is needed to upgrade to HL 7 2.5.1

New system must be developed with interoperability in mind.

Public Health will need to operate dual systems (current and new HIE-based systems) until HIE-based systems are validated and all providers have access.

recommendations for federal agencies to support public health hie
Recommendations for Federal Agencies to Support Public Health HIE
  • Actively engage public health to assure that HIT goals and standards can be achieved and are useful for public health program purposes.
  • Develop national standards for HIE that have been widely vetted in the PH community.
  • Assure data from HIE are valid, accurate and timely. Resources will be needed to assure this validation.
  • Assure that federal funding for categorical public health programs is flexible enough allow cross-program collaboration such as New York is undertaking in its CHI2 initiative.